Spinning Out of Control
Diabetes has become a worldwide epidemic with potentially deadly consequences, yet it remains largely misunderstood and under-diagnosed.

What do Halle Berry, Nick Jonas, and Mary Tyler Moore have in common? From the outset, nothing. But they all have diabetes, and every year nearly two million more people are diagnosed with the same disease. Why has this condition reached epidemic proportions? Theories include everything from an increase in low-nutrient foods to a decrease in physical activity—two factors that are proven to contribute to obesity, in itself an epidemic. To learn more about diabetes and what you can do to protect yourself, read on.

What is diabetes?

Simply stated, diabetes is a group of chronic metabolic disorders caused by the body's lack of or resistance to insulin, the hormone that allows glucose into the cells, where it is then converted into the energy needed for daily life. "Although there are several types of diabetes that need to be managed differently," says Marie Lupo, APN, C, CDE, nurse manager and certified diabetes educator at the Diabetes Center at Overlook Medical Center, "they are all the result of an insulin deficiency or resistance, which allows blood sugar to rise to unhealthy levels."

There are three distinct types of diabetes

Type 1 usually occurs in children and young adults, and was previously known as juvenile diabetes. In type 1 diabetes, the body does not produce insulin. Only five percent of diabetics have this form of the disease, which is managed with the help of insulin therapy and other treatments.

Type 2 is the variation typically associated with the word "diabetes," and tends to strike adults over 40, although obesity has contributed to a rise in type 2 cases among children and adolescents.
In type 2 diabetes, the problem is a combination of insulin deficiency and insulin resistance.

Gestational diabetes strikes expectant mothers, usually around the 24th week of their pregnancy. It resolves after the baby is born, although if a mother remains overweight and physically inactive, she has an increased risk of developing type 2 diabetes.

So how can you tell if you have diabetes? The truth is, it's not so easy to self-detect. "The majority of people with type 2 diabetes have no clear warning signs," explains Sharon Selinger, MD, section chief of Endocrinology and Metabolism at Overlook Medical Center. "Therefore, it's important to screen individuals who may be at risk, such as people with a family history of diabetes, a personal history of gestational diabetes, or people who are overweight." It's not unusual, however, for symptoms to manifest in patients whose blood-sugar levels rise dangerously high, so speak to your doctor as soon as possible if you experience chronic issues like increased thirst, urination, and appetite; unexplained weight loss; frequent urinary tract or vaginal infections; blurred vision; weakness; fatigue; or a sore throat that just won't heal.

A global epidemic

There are currently 26 million diabetics in the United States (about one in ten people), and 366 million worldwide—and these numbers are rising rapidly, says Lupo. "At the current rate of diagnosis, experts expect that by 2050, one in three Americans will have diabetes," she reports. The problem has grown so exponentially that U.N. Secretary-General Ban Ki-moon recently referred to chronic diseases like diabetes and heart disease as "a public health emergency in slow motion."

How did we get to this point? There is no singular answer. "Our population is aging," explains Lupo, "and as we age, our bodies produce less insulin and become more insulin-resistant, leading to more cases of diabetes." But that's only one piece of the puzzle. Adds Selinger, "The risk of diabetes increases as body mass index (BMI) increases, so obesity and sedentary lifestyles also are contributing to the diabetes epidemic."

Many experts believe the problem may be cultural as well. "As our communities become more ethnically diverse, we are seeing more cases of diabetes, especially among African-Americans, Hispanics, and Asian-Americans," says Lupo. The impact of the disease doesn't weigh solely on the patients and the families who love them. "The growing diabetes epidemic stands to create a significant financial burden for our already strapped healthcare system in years to come," Selinger points out.

Living with diabetes

There is no cure for diabetes, but careful management of the disease—which typically involves diet and lifestyle changes and occasionally medication—can ensure that patients live long, healthy lives. But living with diabetes isn't easy, and patients often need constant motivation to stick to the difficult life changes and limitations they face on a daily basis. "Unfortunately there is no quick fix for diabetes, and it can affect every minute of a patient's day and take the spontaneity out of many aspects of their lives, since they need to not only diligently monitor their diet and exercise regularly but constantly check their blood sugar as well," says Lupo. "So most of the work we do here at the Diabetes Center is about encouraging patients to master the skills they need to manage their disease."

There is perhaps no better motivation than the laundry list of life-threatening complications that can develop when diabetes isn't carefully monitored. "Since chronically elevated sugars cause injury to large and small blood vessels, uncontrolled diabetes increases a patient's risk for things like stroke, heart attack, blindness, kidney disease and dialysis, nerve damage, and amputations," says Selinger.

Fortunately, most of these complications are avoidable—and possibly reversible—with proper diabetes control. "We are an education center for patients, their families, and primary care providers or obstetricians to help them manage their condition and be prepared for emergencies," Lupo says of the Diabetes Center at Overlook Medical Center. "But at the end of the day, the patient is really in the driver's seat, which is why we also provide ongoing support and coaching to help diabetics continue to take care of themselves." Not only does Lupo work with patients to discuss every aspect of their disease, but a registered dietician also is on hand to help with nutritional counseling. "All of our patients see both of us at each visit," says Lupo, "and we collaborate to address each patient's specific stumbling blocks and help them meet their wellness goals."